Endoscopic management of Barrett's esophagus

Barrett's esophagus [BE] has a malignant potential. Neither acid suppression nor anti reflux surgery produce consistent or complete regression of metaplastic epithelium. Is to determine the efficacy of endoscopic therapy in management of BE. This study was carried out on 25 patients [18 males and 7 Females], with BE that was confirmed by biopsy and histopatholoay. According to the histopathological examination, 24 patients had BE with no dysplasia or low-grade dysplasia [LGD]. Ablation of Barrett's mucosa in those patients was done using argon plasma coagulation [APC]. Also, one patient who had [BE] with high-grade dysplasia [HGD]. Ablation of Barrett's mucosa in this patient was done using EMR [endoscopic mucosal resection]. As regards APC, successful ablation was achieved with complete clearance of BE in [71%] of patients and during the follow-up period only [12%] of those patients revealed buried BE glands on histopathological examinations. Complications as self-limiting chest discomfort [25%], odynophagia [20%], and temporary dysphagia [4%] were observed during the follow-up period. As regards EMR, it was performed only in one patient who had BE with HGD. The procedure was performed using lift and cut technique. EMR in this study was successful with no complications. Argon plasma coagulation [APC] ablative therapy for [BE] proved to be safe and well tolerated, with only minor self-limiting side effects. -Endoscopic mucosal resection [EMR], in ablation of BE with HGD, is an emerging and promising technique in treatment of 4splastic and malignant lesions within BE

value of plasma matrix metalloproteinase-1 and tissue inhibitor of metalloproteinases-1 estimation as biomarkers of ulcerative colitis activity

Overexpression of mucosal metalloproteinases [MMP] have been demonstrated recently in inflammatory bowel disease. Their activity can be counterbalanced by the tissue inhibitor of metalloproteinases [TIMP]. The aim of this study was to evaluate the effect of ulcerative colitis [UC] on MMP-1 and TIMP-1 plasma concentrations, as two possible biomarkers of the disease activity. MMP-1 and TIMP-1 plasma concentrations were measured with an enzyme immunoassay in 16 patients uuth endoscopically confirmed active UC and 12 healthy controls. Plasma concentrations of both MMP-1 [13.7 +/- 0.2 ng/ml] and TIMP-1 [799 +/- 140 ng/ml] were significantly elevated in UC patients In comparison to healthy controls [11.9 +/- 0.9 ng/ml. and 220 +/- 7 ng/ml respectively]. There was no correlation between TIMP-1 and MMP-1 concentrations [r=-0.02]. TIMP-1 levels revealed significant positive correlations with scored endoscopic degree of mucosal injury, disease activity index and clinical activity index values as well as C-reactive protein concentration. There was no correlation between MMP-1 and laboratory, clinical or endoscopic indices of the disease activity. These results confirm the role of both MMP-1 and TIMP-1 in the pathogenesis of ulcerative colitis. However only TIMP-1 can be useful as a biomarker of the disease activity, demonstrating association, with clinical endoscopic pictures

Modulation of haematological and pathological changes caused by toxoplasma gondii in an experimental model of chronic infection

Wide spectrum of pathologic patterns is encountered in T. gondii infection, ranging from trivial pathology to fatal disease. The study was done to evaluate the ability of some drug groups to reverse the pathological changes caused by T. gondii infection. This evaluation was done, in vivo, in a rat model of chronic infection parallel to that in human. Lung, liver and brain specimens were taken in definite time points respecting the kinetics of infection in that model. Blood counts were done to all groups to evaluate efficacy and toxicity of drugs. A new combination of dipyridamole/ allopurinol was able to significantly reduce the pathology in all organs to almost the baseline pathology of chronic Toxoplasma infection. The relatively moderate protective effect of pyrimethamine/sulfadiazine combination was undermined by the toxic effects evidenced by pathology and haematological parameters. Spiramycin, in spite of proving safe, yet its protective effective is relatively weak in all organs especially in the brain where it seems to offer no protection

Assessment of the role of soluble intracellular adhesion molecule-1 [sICAM-1] in the pathogenesis and as a marker of disease severity in different stages of human schistosomiasis and toxoplasmosis

The role of soluble intracellular adhesion molecule 1 [sICAM-1] in the pathogenesis and its relevance to disease severity was assessed in different stages of human infection with S. mansoni, S. hematobium and T. Gondii. The levels of sICAM-1 obtained in the current study, correlated with disease severity degree of cell destruction and type of immune response. Highest sICAM-1 levels were observed in only two groups [hepatosplenic schistosomiasis and patients with mixed active S. Hematobium and T. gondii infections], while the other two groups [separate cases of active S. hematobium infection or latent T. Gondii infection] showed no significant rise in sICAM-1 levels

Effects of haemodialysis on serum insulin level in nondiabetics end stage renal patients

Chronic renal failure is one of the chronic life threatening diseases affecting human beings. Abnormlities in carbohydrate metabolism have been recognized in non diabetic uremic patient with end stage renal disease [ESRD]. Patients undergoing regular hemodialysis usually develop hypogiycaemic symptoms during the dialysis session .We studied the effects of hemodialysis on the serum insulin level in these patients Analysis of the data obtained from our Study revealed, that, there is a significant increase in blood glucose levels and serum insulin level in uremics Compared to controls. Also serum insulin level was high in hemodialysis uremics before and after dialysis compared to those on conservative treatment These abnormalities may be Contributed to many factors: Such as; Inability of the diseased kidney and the skeletal muscles to degrade insulin. Suppression of insulin binding to erythrocytes of predialysed plasma Augmented gluconeogenesis Increased potassium level. Metabolic acidosis. Increased receptor binding of glucagon. Also, our study showed a significant decrease in serum insulin level after dialysis session but not to the normal values, which may be due to removal of unidentified small and midlle molecular weight peptides from the uremic patient's plasma by dialysis which is Supposed to be responsible for the uremic toxicity and insulin resistance in the peripheral tissues

value of urinary calcium in prediction of pregnancy induced hypertension [PIH]

Maternal and perinatal mortality and morbidity still remain high if PIH is diagnosed late. One hundred normotensive primigravidae participated in this work. Starting from first trimester, the 24 hour urinary calcium excretion was measured at the end of each trimester. Ninety one cases completed follow up program, of them 11 [12%] developed PIH during the third trimester [7 pre eclampsia and 4 gestational hypertension]. The mean 24 hour urinary calcium excretion was significantly reduced [P < 0.001] in patients with pre-eclampsia [172 +/- 9.8 mg / 24 hour] and in patients with gestational hypertension [249.5 +/- 5.9 mg / 24 hour] compared to the normotensive group [296.5 +/- 21.2 mg / 24 hour]. The level was significantly reduced [P < 0.001] during the second trimester in cases who ultimately developed pre eclampsia in third trimester. Similar finding was not observed in gestational hypertension group. This work shows that measurement of urinary calcium during the second trimester is a good indicator for the ultimate development of pre eclampsia in addition to its value in confirming diagnosis of already developed pre eclampsia